SB 975 Summary

• Prohibits dental plans from requiring dentists to provide services at plan-set fees unless those services are covered under the subscriber agreement.

• Defines "covered services" as services reimbursable under the subscriber agreement, subject to contractual limitations such as deductibles, waiting periods, or frequency limits.

• Requires health benefit plans and dental plans to establish appeal procedures for claims denied based on lack of medical necessity.

• Mandates that medical necessity denials be determined by a licensed dentist holding an unrestricted U.S. license, with the dentist's identifier, license number, state of issuance, and contact telephone number included in written denial communications.

• Becomes effective November 1, 2013.